champion of the true hd experience some questions on high … · 2015-09-29 · discover your hd...

www.OkeechobeeTheMagazine.com September/October 2015 | 35

OTM: What should women be looking for during self-exams?

BB: You should be aware of your breast texture and know, for instance, if you have denser tissue in one area or a known stable mass in another area that has been followed so you know when there are changes. Things that should bring you back to your medical provider to eval-uate would be a new or changed hard mass, classically described as something like a “marble” or a “frozen pea,” skin changes such as redness, thickening or dimpling texture like the surface of an orange peel, nipple changes like a new inversion (pulling/facing inward of the nipple) or nipple discharge.

34 | September/October 2015 OKEECHOBEE THE MAGAZINE

Dr. Brandy Becker specializes in obstetrics and gynecology and is a member of Women’s Health Special-ists on the Treasure Coast. Dr. Becker graduated from medical school at the University of Illinois and completed her Ob/Gyn residency at the University of Rochester in New York. Her training incorporated a large volume of high- and low-risk obstetrics as well as min-imally invasive gynecological training with DaVinci Robotics and traditional laparoscopic procedures.

Early detection is the best medi-cine to cure cancer. We spoke with Dr. Brandy Becker to find out what exactly women need to be doing and looking for to help keep cancer at bay.

OTM: How can women assess their risk for breast cancer?

BB: The website http://www.cancer.gov/bcrisktool/ allows women to input known risk factors and gives them a five-year and a lifetime estimation of their risk of developing breast cancer as well as a comparison with an average American woman's risk. If your lifetime risk calcu-lates out to greater than 20 percent, you should speak with your medical provider about any special screening plans and whether you would be a good candidate for genetic screening based on family history review.

Some Questions on Breast Cancer

And Doctors’Answers to Reassure YouBy Rachel Buxton

Breast cancer is scary; there is no other way to put it. Almost everyone knows someone who has been affected by the disease.

And although there are some things that are out of your control, such as genetics, there are still some very powerful steps you can take

that will aid in prevention and in protecting yourself. As with anything else, knowledge is power, so we spoke with three physicians who

answered common questions about this scary and complex — but very treatable — disease.

Q A&

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OTM: If a woman receives a positive result, what should be her next step?

BB: If there is a new finding, she will be called back for further views with a mammogram and maybe even an ultra-sound. No imaging will ever be able to determine for certain that there is or is not a cancer, but there is a gradient of how concerning the findings are, which determines whether it is stable to be deemed a normal variant, or watched with repeat imaging in six months, or referred on to a breast surgeon for a biopsy. This process of waiting for results can be very stressful for women, but one should be reassured not to worry too soon as this is a very common occurrence. Approximately 10 percent of screening mammograms require additional evalu-ation, and 90 percent return as benign.

OTM: What about my family history?

BB: Less than 10 percent of breast cancers have been linked to genetic mu-tations. The largest category is BRCA. While it is the most common form of inherited breast cancer mutation, it is still relatively uncommon in the general population; and historically, the test was quite expensive, so specific guidelines have been set forth for those women who should consider testing.

OTM: When should breast cancer screening tests start?

BB: For average-risk women under age 40, there is no evidence to advise breast cancer screening. It is recommended that women start routine, yearly screenings at age 40.

OTM: Is getting both a mammogram and ultrasound recommended?

BB: Many women ask to have an ultrasound with their annual screening mammogram. In standard low-risk women, this has not been shown to reduce breast cancer mortality and has actually been found to be associated with increased false positive results, meaning you may need to undergo further testing and biopsies but they will not necessarily result in a cancer diagnosis or improved outcome.

OTM: What are the benefits of a 3D mammogram?

BB: 3D, also called tomosynthesis, is an improvement on standard digital mammography. A computer reprocesses the images and divides them into tiny slices (1 millimeter thick), much like you would be able to pick up individual slices of bread and look at those individually instead of the whole loaf. This helps the radiologist view the breast more clearly and accurately. Studies show it may decrease the need for return follow-up images by 20-40 percent and finds 27 percent more cancers and 40 percent more invasive cancers than standard two-dimensional mammograms.

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Every woman fears getting the news that something was spotted on her mam-mogram. Suddenly there are a million questions and what-ifs running through her head. If you do happen to receive the news that something questionable was found on your mammogram, try not to panic. Your next step will be to meet with a breast surgeon. We spoke with surgeon Dr. Carlos Alejo to find out what women can expect during their visit.

OTM: When is a biopsy needed?

CA: Most of the time, a routine screen-ing mammogram reveals abnormalities that may be cancerous, not cancerous, or pre-cancerous. The findings are graded according to their appearance in order to determine which ones need to be sampled with a biopsy. Other risk factors are also taken into consideration, such as family history and changes when compared to previous studies.

OTM: How are biopsies performed?

CA: When the decision is made to go ahead with the biopsy, the doctor will discuss with the patient what the best approach should be. A great majority of patients will be candidates to undergo an image-guided biopsy. Imaging modalities include mammogram, ultrasound and MRI. Some breast lumps are palpable and can be biopsied in the office without image guidance. In rare instances, the biopsy must be obtained in surgery.

OTM: How long does it take to get biopsy results? If surgery is needed, how soon can it be scheduled?

CA: It usually takes two or three days to get pathology reports back. Once the report is available, the surgeon will discuss the findings with the patient and determine whether surgery should be the next step. For larger cancers, the patient may be referred to an oncologist prior to surgery. Chemotherapy may be indicated prior to surgery. Generally, surgery can be scheduled within seven days of receiving the results of the biopsy.

OTM: What determines the extent of the surgery?

CA: Many factors weigh into the final plan for surgery. Patient choice has become a more important factor in the past two decades. It is rarely neces-sary to remove both breasts, although it may be indicated if tests reveal that the patient carries genes that predispose him or her to breast cancer. It is reasonable to perform a mastectomy (removal of the whole breast) if the patient so desires. In most institutions, plastic surgeons are available to perform immediate or delayed reconstruction of the breast.

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Dr. Carlos Alejo is a general surgeon in Okeechobee and is affiliated with Raulerson Hospital. He received his medical degree from Universidad Central del Caribe School of Medicine in Puerto Rico and completed his surgical residen-cy at Mount Sinai Medical Center and Jackson Memorial Hospital in Miami.


Most women are candidates to undergo partial removal of the affected breast, and this is the most common proce-dure performed for breast cancer. It is less common that these patients require reconstructive surgery. Many of the pa-tients in this group will benefit from radiation to the affected breast several weeks after surgery.

OTM: If cancer is found on the lymph nodes, what does that mean?

CA: Lymph nodes are small nodules that exist throughout our bodies and act as drainage points for many organs. Several types of cancers, including breast cancer, travel through the lymph chan-nels. For that reason, as part of most breast cancer surgeries, the surgeon will sample a few of the lymph nodes from the axilla (underarm) closest to the cancer. This is done at the time of the removal of the breast cancer. If cancer has spread to the lymph nodes, the breast cancer is more advanced in stage. This can alter the follow-up and treatment recommen-dations. Although more challenging to treat, it still is curable in many patients.

OTM: What is the recovery time following surgery?

CA: Most people who have a portion of the breast removed go home the same day of surgery and go back to work in a week or two. Mastectomy patients go home usually a day after surgery and are able to go back to work within two to four weeks. Of course, if complica-tions arise, theses time frames may be prolonged.

OTM: Is a preventive double mastectomy recommended?

CA: Most of the time, this is done when a patient is found to carry either the BRCA1 or the BRCA2 gene. Most of these patients have several first-line relatives with history of breast cancer. Testing for the gene is very easy. Rarely, patients will request this procedure without clear indication. Each case is considered independently.

OTM: If I have breast cancer, does that mean I am going to die?

CA: Breast cancer is curable. It is certainly not a death sentence. Not all breast cancer patients survive, but a great majority of patients diagnosed with this condition can be helped with a com-bination of treatments and therapies. Early detection is the key to successful treatment of breast cancer. Those with strong family history of breast cancer need to be screened sooner.

Once your surgeon has performed the procedure you have chosen following a positive mammogram, you will most likely be sent to an oncologist to con-tinue your treatment. Everyone knows about the basic treatment options — chemotherapy, radiation and some sort of drugs/medication — however, there is much more to take into account when it comes to treatment. It isn’t as simple as just selecting a form of treatment. There are several questions that need to be asked and answered before you can move forward with your cancer recovery. Dr. Ramesh Kumar of Big Lake Cancer Center helped answer those necessary questions.


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important step that will give information on the nature (least aggressive to the most aggressive) kind of cancer, its extent and its predicted behavior. The kind of breast cancer you have, your genetic makeup, age, other possible medical issues, your personal emotional status and your environment all will play a role in what treatment you decide on.

OTM: What is the first step in treatment?

RK: The first line of treatment is to simply calm down and to work on your mindset. The word “cancer” alone will create an avalanche of emotions, both internal and external. A cluttered mind will result in confusion, anxiety and the lack of ability to make good decisions. You are either frozen or panicking, both of which are not healthy. You must realize that the only person who can control what goes on in your mind is you. Getting your emotional control back is where your journey to recovery starts. Having someone such as a family member or friend go to your appointments with you will help you feel more comfortable, leading to making better choices.


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Dr. Ramesh Kumar is a board-certified radiation oncologist in Okeechobee. He completed his residency at Wayne State University in Michigan in 1993. He served as a full-time staff member in the Department of Radiation On-cology at City of Hope National Medical Center near Los Angeles, a leading cancer treatment and research institution. Dr. Kumar encourages people to call (863) 467-9500 or text their cancer-related questions to (772) 332-9975, where he will reply with a quick response.

OTM: What treatment is right for me?

RK: The future is never “one size fits all.” You have to take into consideration several factors before you can even begin talking about treatment. Collecting all relevant data is an


OTM: Can I put treatment on hold?

RK: Once a treatment plan is made, implementing it without undue delay is extremely important. Look at your cancer as a bomb with a fuse. The quicker you start, the more time you have to put the fuse out. The longer you wait, the shorter and shorter the fuse gets.

Breast cancer is the most common cancer and the most feared disease among women, but the most important thing to remember when it comes to breast cancer is that a diagnosis is not a death sentence. Survival rates only continue to rise, with the 5-year sur-vival rate for localized breast cancer at 98.6 percent. Technology and treatment have improved incredibly over the years and are constantly evolving, making the disease that much more curable. But no matter how advanced technology and treatment are, you still have to do your part. Early detection is invaluable in treating breast cancer. Performing monthly self-exams and getting your annual mammogram screening can help save your life. It is up to you to take your health into your own hands and to utilize all that is available to help keep you breast cancer-free.

OTM: How do I choose theright treatment option?

RK: It is not about choosing a treat-ment option, it is about picking an option and eliminating the others. When you pick an option, that’s what gives you power. The goal of treatment is to prevent breast cancer from coming back and to prevent it from developing elsewhere in the body. The choices available are personalized to your particular situation and may involve further surgery, radia-tion, chemotherapy, hormonal therapy or some combination. The decision needs to be based on rational thought and information.

OTM: What should I expectwhen moving forward with a treatment plan?

RK: Never forget it is your life you are dealing with and making decisions for. You also have to remember that a treatment plan is only a guide, and as in any area of medicine, be prepared for bumps in the road. Many of them are predictable and preventable, but some are not. The key is to trust your caregivers to hold your hand and walk you through your journey.

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champion of the true hd experience some questions on high … · 2015-09-29 · discover your hd...

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